Abstract 014: Race and Sex-Based Disparities Associated With Carotid Endarterectomy in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Introduction: The indications and risks associated with carotid endarterectomy (CEA) are well established. We sought to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. Methods: We conducted a prospective cohort analysis of 14,754 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study who did not have a diagnosis of carotid artery stenosis at baseline (1987-1989). We estimated the cumulative incidence of CEA by sex and race using the Kaplan-Meier method. We used Cox proportional hazards models with adjustment for sociodemographic, cardiovascular, and disease severity risk factors to quantify the association of sex and race with incident CEA. Cardiovascular risk factors (hypertension, coronary heart disease, chronic kidney disease, diabetes), carotid intima media thickness(IMT), and symptomatic status (stroke or symptomatic carotid artery stenosis based on hospital diagnosis codes) were adjusted as time-varying exposures. Results: CEA was performed in 345 of 14,754 ARIC participants over a median of 27 years follow-up [incidence rate 1.04 (95%CI 0.93-1.15) per 1,000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.58 (95%CI 0.47-0.72)] and race [black vs. white: HR 0.63 (95%CI 0.48-0.84)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid IMT, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.82 (95%CI 0.65-1.03)], but black participants had a persistently lower risk of incident CEA despite adjustment [HR 0.64 (95%CI 0.45-0.89)]( Figure ). Conclusions: While there are known sex and race-based differences in the prevalence of carotid artery stenosis, we found significant variation in the incidence of CEA based on race that is independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.